title: Hydroxyethyl starch reduces coagulation competence and increases blood loss during major surgery: results from a randomized controlled trial.
abstract: OBJECTIVE
  This study evaluated whether administration of hydroxyethyl starch (HES) 130/0.4 affects coagulation competence and influences the perioperative blood loss.
  
  
  BACKGROUND
  Artificial colloids substitute blood volume during surgery; with the administration of HES 130/0.4 (Voluven, Fresenius Kabi, Uppsala, Sweden) only a minor effect on coagulation competence is expected.
  
  
  METHODS
  Eighty patients were scanned for enrollment in the study, and 40 patients fulfilled the inclusion criteria. Two patients withdrew their consent to participate in the study, and 5 patients were excluded. Thus, 16 patients were randomized to receive lactated Ringer's solution and 17 to receive HES 130/0.4.
  
  
  RESULTS
  Among the patients receiving HES 130/0.4, thrombelastography indicated reduced clot strength (P < 0.001) and blinded evaluation of the perioperative blood loss was 2.2 (range 0.5 to 5.0) versus 1.4 (range 0.5 to 2.4) L in the patients who received HES 130/0.4 or lactated Ringer, respectively (P < 0.038). The patients in the lactated Ringer's group, however, received more fluid (P < 0.0001) than those in the HES 130/0.4 group. There was no significant difference between the 2 groups with regard to frequency of reoperations or the length of hospital stay, but use of HES 130/0.4 was both more expensive and less efficacious than the use of lactated Ringer.
  
  
  CONCLUSIONS
  Administration of HES 130/0.4 reduced clot strength and perioperative hemorrhage increased by more than 50%, while administration of lactated Ringer's solution provoked an approximately 2.5 times greater positive volume balance at the end of surgery.
authors.affiliation: *Department of Anesthesiology, The Abdominal Centre †Section for Transfusion Medicine ‡Department of Urology; and §Center of Head and Ortopaedic Surgery, Rigshospitalet, University of Copenhagen, Denmark.
authors.forename: Kirsten C
authors.initials: KC
authors.lastname: Rasmussen
authors.forename: Pär I
authors.initials: PI
authors.lastname: Johansson
authors.forename: Michael
authors.initials: M
authors.lastname: Højskov
authors.forename: Irina
authors.initials: I
authors.lastname: Kridina
authors.forename: Thomas
authors.initials: T
authors.lastname: Kistorp
authors.forename: Peter
authors.initials: P
authors.lastname: Thind
authors.forename: Henning B
authors.initials: HB
authors.lastname: Nielsen
authors.forename: Birgitte
authors.initials: B
authors.lastname: Ruhnau
authors.forename: Tom
authors.initials: T
authors.lastname: Pedersen
authors.forename: Niels H
authors.initials: NH
authors.lastname: Secher
mesh_terms: D000368:Aged; D001777:Blood Coagulation / Q000187:drug effects*; D001780:Blood Coagulation Tests; D016063:Blood Loss, Surgical / Q000517:prevention & control / Q000706:statistics & numerical data*; D003362:Cost-Benefit Analysis; D015653:Cystectomy / Q000191:economics; D003718:Denmark; D004311:Double-Blind Method; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000009:adverse effects* / Q000191:economics / Q000627:therapeutic use; D020896:Hypovolemia / Q000209:etiology / Q000517:prevention & control*; D007431:Intraoperative Complications / Q000097:blood / Q000139:chemically induced / Q000191:economics / Q000517:prevention & control; D007552:Isotonic Solutions / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010952:Plasma Substitutes / Q000009:adverse effects* / Q000191:economics / Q000627:therapeutic use; D011183:Postoperative Complications / Q000097:blood / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control; D011446:Prospective Studies; D000077325:Ringer's Lactate; D016896:Treatment Outcome
chemical_list: C485123:HES 130-0.4; D006895:Hydroxyethyl Starch Derivatives; D007552:Isotonic Solutions; D010952:Plasma Substitutes; D000077325:Ringer's Lactate